International consensus definition of low anterior resection syndrome

Abstract

Aim:

Low anterior resection syndrome (LARS) is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The LARS score was designed as a simple tool for clinical evaluation of LARS. Although the LARS score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of LARS that encompasses all aspects of the condition and is informed by all stakeholders.

Method:

This international patient–provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting. Three expert groups participated: patients, surgeons and other health professionals from five regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in three languages (English, Spanish, and Danish). The primary outcome measured was the priorities for the definition of LARS.

Results:

Three hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96% and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to eight symptoms and eight consequences that capture essential aspects of the syndrome. Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this.

Conclusion:

This is the first definition of LARS developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of LARS. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in LARS over time and with intervention.

Metadata

Item Type:	Article
Authors/Creators:	Keane, C Fearnhead, NS Bordeianou, L Christensen, P Espin Basany, E Laurberg, S Mellgren, A Messick, C Orangio, GR Verjee, A Wing, K Bissett, I An, V Bryant, A Byrne, C Chen, T Clark, D Croft, S Dinning, P Gladman, M Heriot, A Kariappa, S Keck, J Lubowski, D Khera, A Kirkwood, K Petersen, D Sloots, K Totten, B Weston, M Andersen, P Bachmann, C Barht, H Emmertsen, K Faaborg, P Gögenur, I Ingerslev, P Isaksen, D Iversen, H Iversen, L Jacobsen, K Jansen, T Jocobsen, I Juul, T Kjær, D Krogh, K Majgaard, M Mynster, A Neuenschwander, A Nielsen, C Nielsen, M Nielsen, R Nielsen, T Olsen, J Poulsen, B Rahr, H Snedker, B Sørensen, G Stolzenburg, T Vaabengaard, P Acheson, A Andreyev, J Bach, S Battersby, N Bradbury, J Brown, S Cecil, T Chapman, M Chapman, S https://orcid.org/0000-0003-2413-5690 Chave, H Cook, T Cuffy, L Davies, J Dawson, C Dixon, J Duff, S Edwards, C Geh, I Hamilton, C Hancock, L Harji, D Hill, J Holtham, S Jenkins, J Johnston, R Kapur, S Maxwell‐Armstrong, C McArthur, D Moran, B Norton, C Nugent, K Pateman, L Perston, Y Rockall, T Sagar, P Saunders, M Sebag‐Montefiore, D Senapati, A Singh, B Skaife, P Smart, N Sykes, H Taylor, C Thorpe, G Tierney, G Voyce, S Walsh, C Warren, O Wheeler, J Woodward, A Winter, D Abbott, S Beban, V Bennett, M Chadwick, T Collinson, R Corbett, S Dennett, E Eglinton, T Fraser, A Glue, J Hohaia, D Menzi, E O’Connor, M Stevenson, D Wells, C Wolyncewicz, S Woodfield, J Bence, K Boutros, M Brueseke, M DeKorte, J Floruta, C Francone, T Frederick, F Grasso, J Gurland, B Higgins, K Hull, T Keller, D Laffan, A Lovett, S Marlatt, J McAdams, D McCarthy, C Milch, H Natale, S Pappou, E Paquette, I Pulskamp, S Rich, M Savitt, L Shafi, M Steele, S Stein, S Tolbert, M Varma, M Vogler, S Vuong, T Wells, K Wexner, S Wo, J Wright, J Wunderlich, C Campbell, K Lim, M Moug, S Oliphant, R Araujo‐Ferreiro, M Ballester, C Belen‐Bueno, A Blanco‐Colino, R Carrillo‐Moreno, J Castillo, J Codina‐Cazador, A Enriquez‐Navascuez, JM Gallego‐García, M Jerez, J Jimenez, LM Labaka‐Aretaga, I Martin‐Fernández, M Martinez‐Sanchez, C Muñoz, A Paniagua‐Cayetano, G Pascual‐Damieta, M de la Portilla, F Ramirez, L Sanchez‐García, C Vaquer‐Casas, G Vico‐García, E Vigorita, V Adams, R Cornish, J Davies, M Evans, M Torkington, J Turner, J
Copyright, Publisher and Additional Information:	© 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Colon and Rectal Surgeons, by John Wiley & Sons Limited on behalf of the Association of Coloproctology of Great Britain and Ireland and by John Wiley & Sons Australia on behalf of the Royal Australasian College of Surgeons. This is an open access article under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND
Keywords:	Consensus definition, low anterior resectionsyndrome, patient-reported, rectal resection
Dates:	Published: March 2020 Published (online): 10 February 2020 Accepted: 23 August 2019
Institution:	The University of Leeds
Depositing User:	Symplectic Publications
Date Deposited:	16 Dec 2021 11:03
Last Modified:	16 Dec 2021 11:03
Status:	Published
Publisher:	Wiley
Identification Number:	10.1111/codi.14957
Related URLs:	PubMed URL
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:181285

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International consensus definition of low anterior resection syndrome

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